Atopic dermatitis: natural remedies, without pharmaceuticals

Definition

Atopic dermatitis (eczema) is characterized by dry, reddened and itchy skin in various locations of the body. In severe cases, the dermatitis may exudate and then scab. Atopic dermatitis occurs in individuals who are atopic, which means in those who respond more sensitively to certain stimuli. Atopic dermatitis has its roots in genetics, with the atopic person’s family, parents or other relatives also having (had) the condition or other forms of atopy. In addition to dermatitis, the most common forms of atopy are atopic asthma and atopic rhino-conjunctivitis.

Onset of atopic dermatitis

Atopic dermatitis occurs in infants from two to four months of age. In children, it will likely appear at around one year of age, or between the ages of six and eight. In adults, atopic dermatitis can appear at any age between adolescence and the age of sixty.

Affected areas

Atopic dermatitis most commonly affects the areas around the mouth, the cheeks and around the eyes.

In the latter, it is referred to as eyelid dermatitis if the eyelids are also affected.

On the feet and hands, atopic dermatitis will usually affect the dorsal areas.

On the arms, dermatitis usually occurs in the elbow crease.

On the legs, dermatitis usually occurs on the back of the knees.

In children, dermatitis will often appear on the torso.

In both children and adults, dermatitis often affects the neck.

Atopic dermatitis can also affect the lips, causing dryness and cracking.

When atopic dermatitis appears on the scalp, it will cause dryness, dandruff and itchiness.

Aotpic dermatitis can also appear on the mammary areola in both males and females. Here, it causes an itchy, exudating eczema to develop.

Causes

While the exact causes are practically unknown, atopic dermatitis is the result of a state of cutaneous hyper-reactivity to common stimuli that can commonly be found within families.

Known triggers

Some known triggers of atopic dermatitis include: change of seasons; humid environments; lack of sun exposure; contact with dust in the environment; contact with animal dander; too frequent washing; physical and/or mental fatigue; emotional stress; ongoing illness and, the use of some pharmaceuticals.

Predisposition

Individuals with atopic dermatitis are predisposed to other reactive forms such as pollinosis (atopic rhinitis) and atopic bronchial asthma. They may become sensitive to nickel and may have acute adverse reactions to some medications. Individuals with atopic dermatitis are also more likely to develop bacterial (impetigo) or viral (herpes, warts or molluscum contagiosum) infectious skin diseases.

Treatment

There is no exact treatment for atopic dermatitis because the cause of the condition is unknown. Therefore, treatment efforts should, where possible, focus on preventing and eliminating concomitant triggers.

The most common errors when attempting to treat atopic dermatitis

Water and hydrating creams

Atopic dermatitis always causes dry skin and may cause skin redness. It’s natural to think that these symptoms would improve by keeping the skin well hydrated but, unfortunately, this is not the case. Indeed, applying an emulsion moisturizer (contains emulsifiers) causes two problems. First, the emulsifiers in the cream interact with the lipids in the skin by emulsifying them, which further weakens the epidermal barrier function that is already defective in the atopic individual. Second, adding water and fat to the surface of the skin can cause bacterial development, which may cause dysbiosis that is considered a key contributor to atopic dermatitis. For these two reasons, applying moisturizing creams in atopic individuals only results in increased skin dryness and inflammation.

Water

Even water alone creates problems for the atopic person. The skin produces some substances with water-soluble moisturizing properties that actually dissolve in water, causing the skin to become dry. A common example of this problem is when the skin becomes dry following frequent hand washing. In an atopic individual who already has dry skin to begin with, washing with water only worsens a problem that, moreover, cannot be solved with regular moisturizers or creams.

Humidity

Moisture is also considered an aggravating factor for atopic dermatitis because it causes skin bacteria (specifically staphylococcus) to develop, causing dysbiosis which is a trigger of atopic dermatitis. In practice, this means that if an atopic person wears synthetic clothing that increases the moisture content of the skin, they should expect the atopic dermatitis to worsen. The opposite will happen if the individual wears clothing made from breathable, natural fibers.

Inconsistencies in treatment guidelines for atopic dermatitis

Although treatment concepts are simple and may seem almost intuitive, national and international treatment guidelines still often recommend frequent bathing, moisturizing creams and the use of wet compresses all of which will maintain or worsen atopic dermatitis.

Antihistamines

Another common mistake in the management of atopic dermatitis is the prescription of antihistamines. These are likely given as treatment because itching is one of the most common symptoms of the condition.
However, atopic dermatitis is neither an allergic reaction nor an autoimmune disease, and the cause of itching is not histamine. The itchiness that accompanies atopic dermatitis is caused by lymphocytes that travel to the skin and discharge itchy, inflammatory mediators.
The use of antihistamines will not treat atopic dermatitis, however antihistamines with hypogenic properties are sometimes used to help children sleep should the atopic dermatitis be causing a severe lack of rest.

Cortisone

While cortisone is undoubtedly the most widely prescribed pharmaceutical to counter atopic dermatitis disorders, it is actually the least recommended.
It is true that the use of cortisone will heal the main symptoms of atopic dermatitis (redness and itchiness) relatively quickly, due to its immunosuppressive and anti-inflammatory properties. Unfortunately, however, cortisone cannot indefinitely treat atopic dermatitis, meaning that when treatment is suspended, the condition will flare up again as it was before, or even worse. The recurrence of symptoms after discontinuation often prompts the patient to reapply cortisone in vain, which may even lead to cortisone dependency.

Problems with cortisone

Not only is cortisone unable to treat atopic dermatitis, but it also causes damage to the skin and, through absorption, harms the entire body. It can create dependence and tachyphylaxis to the point of triggering cortisone dermatitis or red skin syndrome.

Cortisone damage

When applied to the skin (especially that of a atopic person) over a long period, cortisone can cause numerous issues, including: thinning of the skin, dilation of blood vessels to the point they become visible, causing unwanted hair growth, causing the loss of melanin pigment, similar to vitiligo.
When absorbed into the body after application on the skin, cortisone can cause, among other issues: hyperglycemia (risk of diabetes), weight gain, increased blood pressure, increased appetite, agitation, insomnia.
When applied to the skin, cortisone application can rapidly induce tachyphylaxis, a phenomenon that can occur with the use of any pharmaceutical. In this case, tachyphylaxis means the response to cortisone has diminished and that the individual must apply more and more cortisone to the skin in order to achieve the same anti-inflammatory result.
Particularly in atopic subjects, cortisone can cause red skin syndrome. Following the chronic application of cortisone, red skin syndrome will cause the skin to suddenly become very red, accompanied by intense itchiness and, sometimes, considerable exudation. Despite the fact that this is a toxicity induced by cortisone itself that is difficult to treat, red skin syndrome is not particularly well understood, even among dermatologists. See also: Cortisone in Dermatology: controversies and side effects

Suspending cortisone

When cortisone is used to try to treat atopic dermatitis, the individual will likely want to stop using the product, either because it is not clearing the condition or because it has started to cause damage to the skin. Suspending cortisone will cause two phenomena to occur: rebound and withdrawal.

Rebound

Upon discontinuation of cortisone, there will be a sudden return of the atopic dermatitis that the cortisone had been blocking. During the rebound, atopic dermatitis is usually more severe than it was before starting cortisone.

Topical steroid withdrawal (TSW)

Corticosteroid Withdrawal Syndrome cannot be effectively treated as it only responds to the reintroduction of corticosteroids.
Since corticosteroids cannot be reintroduced, the only available approach to alleviate dermatitis symptoms is through the use of Potassium Permanganate solution for compresses (see Potassium Permanganate solution). This antiseptic has astringent and anti-itch properties. The acute phase of corticosteroid withdrawal typically subsides within approximately 30 days from onset, but the skin remains unstable for several months. The duration of this instability is proportional to the length of corticosteroid use and the dosage administered prior to discontinuation.
However, if corticosteroids have been used for years, withdrawal can affect the entire body, manifesting not only as worsening skin symptoms but also with fatigue, loss of appetite, fever, general malaise, psychological depression, and other systemic symptoms. In many cases, hospitalization may be required for supportive care.
Once the acute phase has resolved, treatment for atopic dermatitis (AD) can be resumed without corticosteroids.

Treating topical steroid withdrawal

When corticosteroids are discontinued, the skin may experience Topical Steroid Withdrawal (TSW), a withdrawal reaction characterized by worsening dermatitis, edema, erythema, exudation, and increased itching.
Skin withdrawal symptoms typically begin 7–10 days after corticosteroid cessation and may last from one month to over a year, depending on the duration of corticosteroid use, potency of the medication, application area, and other factors.

Calcineurin inhibitor immunosuppressants

The calcineurin inhibitors cyclosporine, tacrolimus and pimecrolimus are pharmaceuticals used to prevent organ transplant rejection. More recently, these drugs have also been approved for the treatment of atopic dermatitis. Tacrolimus and pimecrolimus are applied topically, while cyclosporine is taken orally, and all three cause the remission of atopic dermatitis. However, at the same time, they also reduce the skin’s immune defenses. Taking cyclosporine as an example, the drug’s side effects are so severe that it is usually very poorly tolerated by the patient and must be discontinued after just a few months of treatment. Upon suspension of treatment, the atopic dermatitis will rebound.
Individuals with atopic dermatitis are already more susceptible to infectious, bacterial and viral diseases, and the use of the topical tacrolimus or pimecrolimus agents further increases this risk. Like cyclosporine, these drugs can also only be used for short periods and, upon the onset of complications, discontinued.

Diet and atopic dermatitis

There is a lot of medical and nonmedical speculation over diets and foods that supposedly cause stress and confusion to those with atopic dermatitis.
While it is true that some foods in some individuals aggravate symptoms, it is also true that eliminating these foods completely will do nothing to improve atopic dermatitis.
Before eliminating a specific food from the diet, it is important to ascertain whether it is actually linked to atopic dermatitis or not.
To do so, the atopic individual must eliminate the specific food from their diet, before reintroducing it several times. During this cycle, they must monitor atopic dermatitis symptoms carefully to check whether or not it worsens. However, there is no such thing as a specific diet for atopic dermatitis and individuals with the condition can eat whatever they wish. Unfortunately, for the same mistaken reason that antihistamines are given to treat atopic dermatitis, so too are histamine-free or diets free from histamine-releasing foods prescribed. These diets provide no benefit to sufferers of atopic dermatitis simply because, as mentioned, histamine is not the cause of atopic dermatitis or the itchiness that it triggers.
The administration of dietary supplements or milk enzymes is also pointless in the treatment of atopic dermatitis.

Allergy testing and atopic dermatitis

Allergy tests such as the prick test (performed on the forearm with a small prick) often cause more harm than good in cases of atopic dermatitis. Even with the condition in remission, individuals with atopic dermatitis have specific cutaneous reactions to these tests which will likely only cause further frustration and confusion.
Blood tests and RAST (radioallergosorbent test) are unreliable, especially in children. Another common mistake is the prescription of epicutaneous allergy (patch) tests that only create considerable irritation for the atopic individual, meaning any results cannot be properly deciphered. Atopic dermatitis is not a disease caused by an allergy. Any allergies that may coexist alongside the condition are not the cause of atopic dermatitis and should be disregarded as such. For example, an allergy to nickel (sulfate) is very common in individuals with atopic dermatitis, but nickel is not the cause of the dermatitis.
In summary:

Water worsens dermatitis

By constitution, atopic individuals have dry skin. Many believe that applying water or moisturizers to the skin will improve dryness, when actually the complete opposite happens.
In an atopic individual, wetting the skin will only increase dryness and itching because the water will dissolve the skin’s natural moisturizing factors. Furthermore, the additional moisture that washing creates causes the over-development of skin bacteria and increased inflammation. Water is even applied to the skin through emollient or moisturizing creams, which will also cause increased inflammation.

Treating atopic dermatitis without pharmaceuticals

Before commencing a treatment plan, the individual must try to eliminate any triggers of atopic dermatitis, as this is the key to successfully resolve the condition. This means avoiding contact with any triggers such as environmental dust or animal dander, and not wearing synthetic fibers such as viscose; avoiding water and reducing stress as much as possible.

Washing and atopic dermatitis

For the treatment of atopic dermatitis, the first and most useful step is to suspend washing.
Not only does atopic dermatitis worsen with water, it also worsens if soaps or various detergents are used.
For the quicker remission of atopic dermatitis, adopt “dry” washing with potassium permanganate, which is an astringent, antiseptic in an aqueous solution that maintains hygiene without drying the skin.

Potassium permanganate

Potassium permanganate (chemical formula KMnO4) is a powder that must be weighed by the pharmacist in doses of 125mg. To make the washing solution, bring one liter of water to boil in a pot. When water reaches boiling point, add a 125mg dose of potassium permanganate. After one minute of boiling, the powder will have dissolved and the solution is ready. Once the solution has cooled, decant into dark glass bottles (such as those used for wine or oil), clearly labeled as “disinfectant.” The solution will remain active for one month.

How to “dry” wash

To maintain body hygiene without bathing, showering and/or using detergent, the following “dry” washing routine should be adopted:

• take a cotton towel that is at least the size of a pillowcase
• place the towel at the bottom of the sink
• wet it with the potassium permanganate solution
• wring out the cotton cloth completely
• with the damp towel, first massage the hair before continuing to the rest of the body
• do not rinse; blot any residual moisture with a towel and dress as normal
• Wash once per day following the above routine.

“Dry” washing with Potassium permanganate solution allows the individual to maintain excellent body hygiene without wetting the skin, thus avoiding any additional inflammation.

The use of topical non-pharmaceuticals to treat atopic dermatitis

To avoid the aforementioned side-effects that can occur with pharmaceuticals while treating atopic dermatitis, DermaClub has developed a treatment routine involving:

1. anti-inflammatories
2. healing ointment
3. soothing powders in cream
4. emollient in ointment

1. Anti-inflammatories

The most active natural anti-inflammatory reducer is coal (mineral) tar.
Coal tar is a distillate of fossil coal that has anti-inflammatory and antipruritic properties.
Coal tar is a powerful photosensitizer, meaning it causes increased sensitivity to light and therefore should not be used during the spring or summer.
Coal tar also has a distinctive, somewhat unpleasant smell and can stain clothing.
Despite these disadvantages, it is still the most powerful natural anti-inflammatory product known. In the treatment of atopic dermatitis, coal tar at a concentration between 0.1% and 1% is applied in the evening in the form of a lotion, cream or ointment. ​​Coal tar is not sold in Italy but can be purchased in countries including the UK, Ireland and the US. Unfortunately, coal tar is often confused with vegetable tar (e.g. pine tar, birch tar, juniper tar, etc.) which is actually an irritant.
Ichthyol sulfonate: a natural anti-inflammatory Ichthyol sulfonate (ichthammol) is a natural product, derived from marine sediments that date back to the Mesozoic period (200 million years ago). With a high safety profile, ichthyol sulfonate also has anti-inflammatory, antimicrobial, antipruritic and soothing properties. For the treatment of atopic dermatitis, a concentration of 10% ichthyol sulfonate. This concentration can be found within the vaseline-free, evanescent Dermictiol Cream, a small amount of which should be applied in the evening to the affected areas and massaged well until absorbed.
Although ichthyol sulfonate also has a distinctive odor that cannot be masked by scent, it is usually accepted.
Unlike coal tar, ichthyol sulfonate is not photosensitizing and can be used throughout the year.
It can be applied to any part of the body.
Ichthyol sulfonate, can also be found in Dermictiol Shampoo meaning the scalp can also benefit from its anti-inflammatory, antipruritic and soothing properties.

2. The soothing powder in cream

The classic soothing agents zinc oxide and magnesium silicate have anti-inflammatory, astringent and anti-itch properties.
Both agents should be used at a maximum concentration of 3%, otherwise they will likely dry out the skin too much. Zinc oxide and magnesium silicate should also be incorporated into a vaseline-free, evanescent cream such as Soothing Cream, which will fully moisturize the skin without causing occlusion.
In cases of mild atopic dermatitis, Soothing Cream can be used on its own as treatment. In more severe cases, it can be used in conjunction with ichthyol sulfonate or coal tar.

3. Healing ointment

In many cases of atopic dermatitis, cracks or cuts can appear spontaneously in particularly inflamed areas, or as the result of scratching.
Before applying any anti-inflammatories or soothing creams, it’s important to let these cracks or cuts heal. In order to do so, DermaClub’s protocol involves the use of PEG Ointment which contains polyethylene glycol and allantoin.
PEG Ointment does not create any moisture and facilitates the faster healing of skin lesions. It is the only balm that can be used when atopic dermatitis is inflamed, red, itchy or exudating because other products will not be well tolerated by the skin.
PEG Ointment can also be applied to skin in withdrawal following the suspension of long-term topical cortisone for dermatitis. See also: Cortisone in Dermatology: controversies and side effects For these reasons, PEG Ointment is often the first point of call for the treatment of atopic dermatitis.

4. Emollient in ointment

When skin redness has faded, but the phase of extreme dryness remains, Extreme Emollient Ointment can be applied to restore skin softness and to reduce flaking and itching. Extreme Emollient Ointment is free from water, vaseline, silicones, animal or vegetable fats, and softens the stratum corneum by drawing water up from deep layers of the skin and holding it on the skin’s surface.

How sun exposure can improve atopic dermatitis

The sun (not UV lamps) has an excellent anti-inflammatory effect on all forms of atopic dermatitis. Gradual, responsible sun exposure without sunscreen is recommended and, as soon as symptoms begin to regress, the individual may also resume swimming in the sea, as long as this is followed by a fresh water shower.
It is important to note, however, that if an individual is being treated, or has recently been treated, with cortisone or immunosuppressants, they will not benefit from the sun’s rays.

When to resume washing with water and soap

As soon as atopic dermatitis has gone into remission (itchiness, redness and dryness have gone), the individual may resume regular washing with water and soap.
However, to avoid relapse, showers should be short and the body should be washed with Eudermic Washing Base, which is a quick-rinsing, non-foaming cleanser that is particularly suitable for atopic individuals.
For any assistance in the treatment of atopic dermatitis and/or the discontinuation of pharmaceutical treatments, post on the Forum, which can be found directly on the website.